Congenital coronary artery anomalies in adult population detected using dual source ECG-gated CTA in a single institution.

BACKGROUND: Congenital anomalies of the coronary arteries (CAs) are rare and are often diagnosed incidentally during a conventional coronary angiography. Recently, the incidence of these congenital defects is on the rise particularly after the introduction of the electrocardiography (ECG) gated coronary computed tomographic angiography (CCTA). This innovative radiological screening modality has led to the most precise mapping of the course of the CAs on computed tomographic scan. The aim of the study is to determine the prevalence and describe the CAs congenital anomalies and their variations in Kuwaiti population at a single institution experience. MATERIALS AND METHODS: We analysed the CCTA data obtained consecutively from 842 patients (2013-2014), retrospectively. The inclusion criteria for patients' selection were: atypical chest pain, equivocal ECG, assessment of patency of coronary stents or grafts and pre-operative screening. Information was acquiesced using a dual-source CT scanner with ECG gating. RESULTS: Data analysis revealed that 22 (2.61%) patients were found to have CA anomalies out of the 842 patients who underwent CCTA. Out of these CA anomalies, 13 cases showed more than two ostia, 7 cases showed the ectopic origin of a CA from opposite sinus or non-aortic sinus, 2 cases showed single coronary ostium and 1 case showed coronary artery with pulmonary fistula. Also, myocardial bridging was identified in 78 (9.26%) patients whereas ramus intermedius branch was identified in 160 (19%) patients. CONCLUSIONS: The prevalence of CA anomalies in Kuwait was 2.6%, which is relatively higher than previously reported studies from different countries.

Glomerular pathology in leprosy. An electron microscopic study.

Electron microscopic examination of renal biopsies from 19 patients with leprosy who had edema, proteinuria, or hematuria showed a proliferative glomerulonephritis in 12, amyloidosis in 2, and no lesion in 5. The proliferative glomerulonephritis was of different patterns: diffuse with or without exudation, focal, or mesangial. Subendothelial and/or subepithelial deposits were seen in five biopsies. Of the patients with glomerulonephritis, 3 had a reduced total serum complement level, 5 had erythema nodosum leprosum, 5 had evidence of recent streptococcal infection, and 2 had microfilariae in the peripheral blood. The significance of these findings is discussed.

First case of subcutaneous zygomycosis caused by Saksenaea vasiformis in India.

The first case of subcutaneous zygomycotic infection caused by Saksenaea vasiformis in a rice mill worker from India is described. The infection, confined to the man's left foot, showed multiple draining sinuses, inflammation, and intermittent low-grade fever following a crushing injury when a log fell on his foot. Histopathologic examination of two biopsy specimens, taken at 3-wk intervals, revealed the presence of broad, sparsely septate, branched, hyaline hyphae characteristic of a zygomycete. When they were grown on a nutritionally deficient medium, two cultures isolated from the biopsied tissues formed numerous, vase-shaped sporangia typical of S. vasiformis. Necrosis of the affected area led to amputation of the fore part of the foot. A split thickness graft was well accepted, and treatment with potassium iodide, following the graft, cured the infection.

HIV seropositivity among patients with sexually transmitted diseases in Vellore.

In a prospective, systematic investigation, 2215 new patients with sexually transmitted diseases (STD) were screened for human immuno deficiency virus (HIV) infection during April 1986 to December 1988. Among them 9 were positive for HIV antibody giving a rate of 4/1000. In addition, 5 patients had been referred to our clinic with a diagnosis of HIV infection and STD. Among these 14, there was one married couple. Of the remaining 5 married individuals, 4 were men; the wives of 3 of them were infected but asymptomatic, and were not included in this report. The rate of conjugal infection was 71 per cent. Most (57%) patients belonged to poor socio-economic background; 78 per cent of patients were young, in the age group 15-25 yr. The presenting STD were syphilis, venereal warts, gonorrhoea, chancroid, genital herpes, non-gonococcal urethritis and candidiasis. It appeared that the course of associated STD had not been altered in these HIV infected individuals.

Diagnostic efficacy of cutaneous nerve biopsy in primary neuritic leprosy.

The role of nerve biopsy in the diagnosis of primary neuritic leprosy was evaluated in a study of 77 patients who had symptoms of peripheral neuropathy without hypopigmented patches, positive skin smears, or a skin biopsy consistent with leprosy. A biopsy of a representative cutaneous nerve near the site of the neurological deficit was taken for histopathological examination and acid-fast staining. Nearly half of the patients had leprosy confirmed by nerve biopsy, and the entire spectrum of leprosy was represented. No significant relationship was seen by age or sex or type of neuropathy. The duration of symptoms did not correlate with the severity of nerve damage as seen histologically. The probability of false-positive or false-negative results is discussed in light of clinical management. Being a relatively simple office procedure, a cutaneous nerve biopsy is strongly recommended as an important diagnostic tool, particularly for primary neuritic leprosy.

Cutaneous lupus erythematosus in India: immunofluorescence profile.

The clinical profile and cutaneous lesions of 65 patients with lupus erythematosus (LE) are described. This included 28 discoid LE (13 disseminated, 15 localized), five subacute cutaneous LE, and 32 systemic LE. The need to recognize a pigmented macular form constituting 25% of discoid LE is emphasized. Increased incidence of involvement of the lower lip in discoid LE and pigmentation in systemic LE is noted. Lupus band test was found to be highly sensitive; it was positive for lesional skin of all untreated patients with subacute cutaneous LE and systemic LE, it was, however, not useful on nonlesional skin.

Fixed duration MDT in paucibacillary leprosy.

The World Health Organization (WHO) has recommended a fixed duration of multidrug therapy (MDT) for paucibacillary leprosy which is currently widely implemented in India. A clinico-pathological study was initiated in 1984 to assess the efficacy of this regimen. The clinical and histological responses of the patients to MDT were assessed at the end of 6 months, when their treatment was stopped, and at 2 1/2 years, when they were released from surveillance, and compared with the responses of a matched patient group to conventional dapsone (DDS) monotherapy during the same period. Of 28 patients who completed the MDT schedule, there was less than 60% improvement in 33% of them when treatment was stopped at the end of 6 months and in 20% of them at the end of 2 1/2 years. Of 26 patients receiving DDS monotherapy, 37% showed less than 60% improvement at the end of 6 months but only 8.8% had less than 60% improvement at 2 1/2 years. It is concluded that MDT for paucibacillary leprosy as recommended by WHO may not have a major advantage over DDS monotherapy, since about 20% of those patients on MDT continue to have evidence of active disease when discharged from surveillance.

Intrafamilial transmission of leprosy in Vellore Town, India.

A hospital-based study was done from 1968 to 1991 to determine the risk and extent of intrafamilial transmission of leprosy in relation to the characteristics of the index cases and contacts in urban areas in India. Families were examined by doctors annually. Skin smears were done for contacts of multibacillary (MB) leprosy patients. Person years of follow up were computed for each contact and used as the denominator for computation of incidence rates. Specific rates were computed by age, sex, type of leprosy, smear in index cases, age at registration, and sex of contacts. Of the 120 index cases (81 males, 39 females) 44% were MB; 410 contacts (186 males, 224 females) and 14 co-prevalent cases were registered. The cumulative years of follow up was 2725 years. Fourteen contacts developed the disease (9 TT, 3 indeterminate, and 2 BT); 85.7% were in the 0-14 age group; 12 of 14 patients were detected to have leprosy during the first 5 years. The incidence rate (IR) was 5.1/1000 (males 5.15, females 5.12). The IR was 7.3/1000 and 2.3/1000 among contacts of MB and paucibacillary leprosy patients (p < 0.05). The IR in multiple-case families was 1.8. The importance of active surveillance by a hospital-based survey is emphasized. It should be designed to focus on children younger than 15 years and should be limited to 5 years of follow up.

Risks of treating leprosy in a general hospital.

The Christian Medical College and Hospital, Vellore, with 1208 beds, is situated in an endemic area in which the prevalence of leprosy among adults is 3.4%. Two percent of the beds are occupied by leprosy patients, and about 4000 are seen as outpatients per year. They share with other patients all medical, nursing, laboratory, and other services. The impact of these attitudes and practices on the incidence of leprosy among staff and students was studied. This hospital has 2665 staff, including housekeeping personnel, technicians, nurses, and doctors. There are 777 medical, nursing, and paramedical students. Every employee and student is screened prior to entry into this institution and subjected to routine annual examinations. Of those who at initial screening had no evidence of leprosy, 24 acquired the disease. Sixteen had tuberculoid, two borderline, and six indeterminate leprosy. The attack rate of 0.7% is significantly lower than the incidence or prevalence of leprosy in the area. Factors contributing to this low attack rate are discussed with particular reference to age, sex, educational background, residential status, and area of work. It is suggested that staff and students serving leprosy patients for whom no isolation is practiced do not carry any additional risk of acquiring clinical leprosy.

Concomitants of HIV/STD risk behaviours and intention to engage in risk behaviours in adolescents in India.

A total of 1230 year 11 and 12 anglophone college students, modal age 16 and 17, in three colleges in Mumbai (Bombay), India, were studied with regard to sexual behaviours or risk of sexual behaviours, beliefs about sex, HIV/STD knowledge, and perceived norms regarding sexual behaviours. Data indicated that 8% of males and 1% of females had had sexual experience, but over one-third were not sure at all of being able to abstain from sexual activity with either steady or casual partners. However, perceived norms were slanted toward sexual abstinence for the majority of the sample. Knowledge of the protective effects of condoms was high, although half of those who had had sex did not use condoms. Logistic regression showed that knowledge was higher among males, those who believed it was OK to have sex with a steady partner and that they should not wait until they were older, those who believed that condoms should be used even if the partner is known, and those who believed it was acceptable to have multiple partners. Gender differences in sexual activity and beliefs about sexual activity showed that males were less likely to believe in abstaining from sexual activity and to engage in it. We conclude that this age-group is appropriate for HIV/STD reduction education given the low rate of sexual activity but that, despite knowledge of the importance of condom use, the social skills to apply this knowledge are lacking.

Study of perceived norms, beliefs and intended sexual behaviour among higher secondary school students in India.

The objective of this paper is to understand the intended sexual and condom behaviour patterns among teenage higher secondary school students in India. To achieve this, variables including perceived norms, perceived peer group norms, risk behaviour patterns, perceived chances of getting AIDS and relevant sociodemographic variables were regressed on intended sexual behaviour. Regression of actual sexual behaviour was carried out with perceived norms, perceived peer group norms and intended sexual behaviour as the independent variables. In this paper a conceptual model has been framed based on the theory of reasoned action, health belief model and self-efficacy theory. Cumulative scores are computed for perceived norms, perceived peer group norms, risk behaviour patterns, opinion on handling condoms and perceived chances of getting AIDS. Along with these variables, possible confounding variables such as age, gender, type of family, mother's education and father's education were considered for their effect on intended sexual and condom behaviour. The results revealed that perceived norms and perceived peer group norms showed significant association with intended sexual behaviour and actual sexual behaviour and that children of more highly educated parents are less likely to engage in sexual activities in their adolescent years.

Renal transplantation in leprosy.

A patient with tuberculoid leprosy and chronic renal failure was given a renal allograft after 5 months of dapsone (DDS) treatment. The leprosy showed continued healing in spite of immunosuppression and was not a significant cause of morbidity. Tuberculoid leprosy does not appear to be a contraindication for renal transplantation.